Is Alcoholism A Mental Health Issue

Alcoholism is listed in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM is the most authoritative guide to mental health conditions and disorders, used globally to diagnose conditions by doctors and mental health practitioners – meaning it is categorised as a mental health issue. Alcoholism is listed in the DSM-5 as Alcohol Use Disorder (AUD) and comes under the category of Substance Use Disorders (SUD).

It’s worth noting that diagnoses change, and this is reflected in how they’re presented in different editions of the DSM. This is because our understanding of conditions and how we treat them develops over time. For instance, the DSM-4 had two categories for conditions related to substances – Substance Abuse Disorder and Substance Dependence Disorder. This split elements of addiction into two categories. Substance abuse refers to patterns of substance use that lead to negative consequences, like problems with jobs, relationships and the law. Substance dependence refers to being physically dependent on substances – being unable to stop taking them without withdrawals and cravings.

The DSM-5 scrapped this distinction and brought both conditions together under Substance Use Disorders. There were several reasons for this, but a major one was the discovery that splitting the diagnosis up in this way didn’t help with treating the problem.

No matter the edition of the DSM you’re looking at, the fact that alcoholism is listed there means that it is indeed considered a mental health condition. However, sometimes people get confused because alcoholism often happens alongside other mental health conditions. In fact, it’s very common to struggle with other mental health conditions alongside alcoholism.

Dual diagnosis

A dual diagnosis means having a diagnosable mental health condition and a substance abuse issue at the same time. A US survey – The National Comorbidity Study – found that this occurs at a rate of about 48%. They also found that in most cases, the mental health condition came before the misuse of alcohol, but alcohol abuse could cause other mental health conditions, most commonly mood disorders like depression. For this reason, alcoholism and other mental health conditions can be said to have a bi-directional relationship: that means one thing can cause or have an impact on the other.

The bi-directional impact of Alcohol Use Disorder and other mental health conditions makes sense. Alcohol is a coping mechanism that many people employ to deal with painful mental health issues, and it also has a profound effect on our bodies and neurochemistry, which can create further issues for our mental health. However, it’s often much more complex than this simple explanation.

Co-occurring mental health issues

Depression

People can use alcohol to self-medicate their depression, and also alcohol misuse can cause depression. Both of these conditions are also very common, so naturally, there would be overlap at the population level. In the UK, 1 in 6 people suffer from depression.
Studies have shown that alcohol worsens the symptoms of depression rather than alleviating them, meaning that using alcohol to self-medicate depression risks making a bad situation worse.

Bipolar disorder

Bipolar disorder can often occur with alcoholism. Bipolar is characterised by periods of depression and mania. Both of these periods can be worsened by alcohol misuse. It can increase depressive symptoms, and also synergise badly with the poor judgement that often accompanies manic episodes, causing people to do things they would not normally do.

Anxiety disorders

It’s no surprise that a substance that’s colloquially called ‘liquid courage’ is often used alongside anxiety disorders such as social anxiety. However, as with depression, using alcohol to self-medicate anxiety risks making the problem worse – alcohol effects, particularly when they are wearing off, often mimic anxiety disorders.

Studies have found that anxiety conditions tend to alleviate with sustained abstinence, and there isn’t a higher prevalence of anxiety disorders amongst people struggling with alcoholism than in the general population. However, there is a high comorbidity rate, which likely reflects a mix of pre-existing anxiety disorders and substance-induced anxiety disorders.

Like depression, anxiety is very common. In the UK, 8 million people are experiencing an anxiety disorder at any one time – approximately 11 percent of the population.

Antisocial personality disorder

Alcoholism is associated with a 21-fold increase in the likelihood of being diagnosed with antisocial personality disorder. The reason for this could be disinhibition – this is an element of antisocial personality disorder, which could cause someone to drink more. Additionally, alcohol causes disinhibition, meaning it can exacerbate antisocial behaviours.

Schizophrenia

Schizophrenia is not a common mental health condition – the lifetime prevalence is about 1.4% of the UK population. However, there is a fourfold increase in schizophrenia in people who have alcoholism. Schizophrenia is highly heritable – about 80-85% of the risk of schizophrenia is down to genetics. It’s theorised that schizophrenia causes people to be vulnerable to alcoholism as it’s associated with dysfunction in the brain’s reward circuitry.

Post-traumatic stress disorder

PTSD and substance abuse commonly co-occur. Trauma can cause significant changes in the brain, affecting areas associated with both calming and arousal, which can leave people who are vulnerable to substance misuse to try to self-medicate the symptoms of PTSD, such as emotional dysregulation, with substances.

Nature or nurture?

The question of whether alcoholism and other mental health conditions are caused by genetics or the environment is hard to answer. They seem to be caused by a complex interaction of both, but some are more heritable than others, as we saw with schizophrenia. Bipolar also has more of a genetic basis, accounting for 80% of the risk.

Alcoholism risk is about 50% genetic(16), as is antisocial personality disorder and depression, while anxiety risk is thought to be about 30% genetic. Even PTSD, which is triggered by trauma, has a genetic component. Studies found that adult children of Holocaust survivors with PTSD had a higher risk of developing it themselves than children of survivors without PTSD.

Treatment

Alcohol addiction treatment cannot simply treat alcoholism in isolation if someone is suffering from a dual diagnosis. Alcoholism treatment needs to take the impact of the co-occurring mental health condition into account fully to properly treat the issue.

People with a dual diagnosis are more at risk from misdiagnosis and improper treatment and from more severe outcomes related to their conditions like homelessness, legal issues and medical issues. Giving effective alcohol help to a person with a dual diagnosis in alcoholism rehab is more complex than treating just alcoholism.

Treating both conditions at the same time, in one programme, is called integrated treatment. This is beneficial not just because it’s dealing with both issues at the same time. Treating people with a dual diagnosis in the same programmes as people with a single diagnosis of addiction reduces stigma and isolation, and gives them access to community. It also means holistic care is possible – it means it’s more likely that practitioners understand both conditions, meaning the person undergoing treatment feels more understood and cared for.

 

People struggling with a dual diagnosis can feel isolated, stigmatised and hopeless – it’s important to know that help is available and it is possible to find treatment where their needs are understood and the environment is supportive.

Get the right help for you

If you’re looking for support in understanding alcohol addiction or mental health, or if you’re searching for the ideal rehab programme, our team is here to help. Reach out to us today for guidance tailored to your needs.

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